利伐沙班对腹腔镜疝修补术后出血和血栓形成的影响

Effect of rivaroxaban on bleeding and thrombosis after laparoscopic hernia repair

目的 探讨利伐沙班对腹腔镜疝修补手术患者术后出血、深静脉血栓形成(DVT)的影响。方法 选取2021年3月至2023年9月于绍兴市人民医院接受腹腔镜疝修补术治疗的患者122例,采用随机数字表法分为观察组与对照组,各61例,对照组给予低分子肝素治疗,观察组给予利伐沙班治疗。对比两组治疗前后凝血指标、纤溶指标、术后出血事件及DVT发生情况。结果 治疗后,两组纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)均较治疗前下降(均P<0.05),且观察组FIB、PT、APTT[分别为(3.08±0.51) g·L^(-1)、(12.02±1.19) s、(31.68±3.42) s]高于对照组[分别为(1.92±0.46) g·L^(-1)、(10.05±1.27) s、(25.82±3.36) s](t=13.191,8.841,9.546,均P<0.05)。治疗后,两组D-二聚体(D-D)、组织纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)水平均较治疗前上升(均P<0.05),且观察组D-D、PAI-1[分别为(7.98±1.47) mg·L^(-1)、(33.92±6.19) ng·L^(-1)]低于对照组[分别为(11.75±1.68) mg·L^(-1)、(39.72±6.73) ng·L^(-1)](t=13.190,4.954,均P<0.05),观察组t-PA水平高于对照组[(13.02±1.83) ng·L^(-1) vs (11.59±1.79) ng·L^(-1),t=4.363,P<0.05]。两组出血事件及DVT发生率比较均差异无统计学意义(8.20%vs 4.91%、0%vs 4.91%,χ^(2)=0.480,1.367,均P<0.05)。结论 利伐沙班能有效改善腹腔镜疝修补术患者的凝血功能,减少DVT的发生,安全性高。

Objective To investigate the effect of rivaroxaban on postoperative bleeding and deep vein thrombosis(DVT)in patients undergoing laparoscopic hernia repair.Methods One hundred and twenty-two patients who underwent laparoscopic inguinal repair in Shaoxing People's Hospital from March 2021 to September 2023 were selected,and randomly grouped,with 61 cases in each group.Control group was given low molecular weight heparin treatment,and observation group was given rivaroxaban treatment.Then the parameters for coagulation/fibrinolysis,postoperative bleeding events and DVT were compared between two groups.Results After treatment,fibrinogen(FIB),prothrombin time(PT),and activated partial thromboplastin time(APTT)decreased in all patients(P<0.05),and the decrease was more table in observation group compared to control group((3.08±0.51)g·L^(-1) vs(1.92±0.46)g·L^(-1),(12.02±1.19)s vs(10.05±1.27)s,(31.68±3.42)s vs(25.82±3.36)s,t=13.191,8.841,9.546,all P<0.05).An increase was observed in D-dimer(D-D),tissue-type plasminogen activator(t-PA)and plasminogen activator inhibitor 1(PAI-1)in all patients after treatment(all P<0.05),and the levels of D-D and PAI-1 in the observation group((7.98±1.47)mg·L^(-1),(33.92±6.19)ng·L^(-1))was lower than that in the control group((11.75±1.68)mg·L^(-1),(39.72±6.73)ng·L^(-1))(t=13.190,4.954,both P<0.05),the level of t-PA in the observation group was higher than that in the control group((13.02±1.83)ng·L^(-1) vs(11.59±1.79)ng·L^(-1),t=4.363,P<0.05).No statistical difference was found in incidence of bleeding events and thrombosis between two groups(8.20%vs 4.91%,0%vs 4.91%,χ^(2)=0.480,1.367,both P>0.05).Conclusion Rivaroxaban is effective and safe in improving coagulation and reducing the occurrence of DVT in patients undergoing laparoscopic inguinal repair.